title: Outcome of adolescents and young adults with acute myeloid leukemia treated on COG trials compared to CALGB and SWOG trials.
abstract: BACKGROUND
  A retrospective meta-analysis of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) was performed to determine if differences in outcome exist following treatment on pediatric versus adult oncology treatment regimens.
  
  
  METHODS
  Outcomes were compared of 517 AYAs with AML aged 16 to 21 years who were treated on Children's Oncology Group (COG), Cancer and Leukemia Group B (CALGB), and Southwest Oncology Group (SWOG) frontline AML trials from 1986 to 2008.
  
  
  RESULTS
  There was a significant age difference between AYA cohorts in the COG, CALGB, and SWOG trials (median, 17.2 versus 20.1 versus 19.8 years, P < .001). The 10-year event-free survival of the COG cohort was superior to the combined adult cohorts (38% ± 6% versus 23% ± 6%, log-rank P = .006) as was overall survival (45% ± 6% versus 34% ± 7%), with a 10-year estimate comparison of P = .026. However, the younger age of the COG cohort is confounding, with all patients aged 16 to 18 years doing better than those aged 19 to 21 years. Although the 10-year relapse rate was lower for the COG patients (29% ± 6% versus 57% ± 8%, Gray's P < .001), this was offset by a higher postremission treatment-related mortality of 26% ± 6% versus 12% ± 6% (Gray's P < .001). Significant improvements in 10-year event-free survival and overall survival were observed for the entire cohort in later studies.
  
  
  CONCLUSIONS
  Patients treated on pediatric trials had better outcomes than those treated on adult trials, but age is a major confounding variable, making it difficult to compare outcomes by cooperative group.
authors.affiliation: Aflac Cancer Center, Emory University/Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: William G
authors.initials: WG
authors.lastname: Woods
authors.forename: Anna R K
authors.initials: AR
authors.lastname: Franklin
authors.forename: Todd A
authors.initials: TA
authors.lastname: Alonzo
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gerbing
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Donohue
authors.forename: Megan
authors.initials: M
authors.lastname: Othus
authors.forename: John
authors.initials: J
authors.lastname: Horan
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: Elihu H
authors.initials: EH
authors.lastname: Estey
authors.forename: Clara D
authors.initials: CD
authors.lastname: Bloomfield
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
keywords: acute myeloid leukemia; adolescents; antineoplastic combined chemotherapy protocols; young adults